Medical devices needed by prison inmates

If a prison inmate needs use of such medical devices as CPAP or constant oxygen supply – those are two I can think of, there are probably other similar things – are they provided to them at no cost?

How is possession of these devices managed as a potential security issue (i.e. if they might be misused to facilitate escape or to fight with, in some way that I can’t imagine but folks can be very creative when it comes to misusing items in their possession)?

I suppose for CPAP the inmate could sleep in the infirmary every night and therefore not have the device in his possession, although that seems like it could lead to other potential security issues. If an inmate needs constant oxygen supply, they would have to carry it around with them. Maybe they would be sent to a secure medical facility?

I’m curious how these kinds of issues are handled. Do not need answer fast.

CPAP is provided by medical devices that have been cleared by security, for use in their cells. Oxygen concentrators are also supplied in a like manner. If someone needs constant oxygen at concentrations higher than an oxygen concentrator can supply, they will reside in our infirmary.

TENS units can be kept in their units also. But all equipment is inspected regularly, and if tampered with or not used appropriately then it will be removed. CPAP and TENS, anyway. If oxygen is needed, that is sort of vital. But their CPAP use is monitored, and if they do not use the device enough for it to be therapeutically effective, they lose that device too.

And their medical costs are covered, save for co-pays for certain situations.

Otherwise, we do our best to meet legitimate medical needs with appropriate treatments and devices, but if it’s not medically necessary, we don’t provide it. The conflict occurs when the patient believes something is medically necessary when in actuality it is not.

There’s going to be a fair amount of local and regional variation in how different penal institution operators handle this question and I’m not sure any one answer is available. I assume the prison system itself does not provide the devices but if they are provided by private insurance or other government assistance then accommodations may be made.

As an anecdote, BIL spent 90 days as a guest of the county and he was able to bring his own CPAP and keep it in his cell. The staff were not happy with it but it seemed to be the lesser of several evils. I can’t imagine the fecal storm that would have formed if they had denied him the use of it.

No, most prisons provide it out of their budgeted money for inmate health care. Most private insurances do not cover prison-incarcerated individuals, nor will medicare or Medicaid (with some exceptions). Jails may be different.

We’re used to shitstorms from people who demand things that we deem are not medically necessary. When a guy uses his CPAP for an average of 45 minutes a week, we discontinue it (after a warning to change his behavior) because experts in sleep apnea agree that is not sufficient use to treat CPAP appropriately. When someone insists only morphine helps their chronic daily headaches, we still stop the morphine as it is not an appropriate treatment for chronic daily headaches. When we get sued, we win these sorts of cases.

I have no clue about my BIL’s specific medical state. He told me he uses a CPAP and that he was able to bring it into his cell for his own needs. It’s possible the county went along with it on the “it’s easier and cheaper than arguing” theory. If push came to shove, it’s entirely possible the county jail may have prevented my BIL’s use of this device. Thankfully, this fight didn’t happen and my BIL served his time without incident.

My feeling is that denying medical care to any inmate simply wouldn’t be allowed by the courts no matter what the security risk. If necessary, you could isolate an inmate but, for example, you can’t let him die from oxygen deprivation simply because you feel he might blow a hole through his cell door with an oxygen canister.

We certainly deny certain types of medical care, if they’re too risky in a secure setting. One gent had to make do with lesser splints/orthotics for his musculoskeletal problems. He’d taken the metal bits from his last brace, made them into a shank, and stabbed a guard. He complained that the new orthotics he got later were too flimsy and didn’t work as well, but the courts agreed that using perhaps less desirable orthotics was preferable, to prevent harm to others.

I will NOT put my staff at significant risk in order to get the best possible outcome.

We also deny futile or ineffective or unneeded care all the time. We’ve been sued for not providing homeopathic treatments, or megadose vitamin treatments, or the best possible athletic shoes. We don’t lose those cases either.

But we work hard to provide for a patient’s legitimate medical NEEDS.

By not giving anything, wouldn’t you be risking homeopathic overdose?

My proposal to circumvent this was to issue marker pens the patients could use to extend their own lifelines.

Are prisoners allowed to refuse medical care? Prisoners on hunger strikes can be force-fed, but can inmates be forced to take medication for life-threatening illness? Can an inmate declare themselves to be DNR?

They still have the right to refuse, but as wards of the state, it’s not an absolute. But to convince a court that forced medications/evaluation/treatment are indicated, we would first need to show a clear and present grave threat to life and limb, and not just a probability of long-term harm from say, refusing their metformin for diabetes, etc.

We will not force dialysis if they’re just tired of dialyzing week after week with no end in sight, but we will try to get a court order to force it if they’re refusing dialysis as a bargaining chip to get a better dialysis shift, or to work with a specific nurse, or get to sit in a particular dialysis chair, too.

We do NOT like to violate patient autonomy to mandate treatment, so try to avoid doing so in all but the most grave situations. And sometimes we take it to court to ask the court “do you want to allow this? Give us a ruling and we’ll abide by it either way, just let us know if it’s a legitimate refusal or not”. As wards of the state, the state does NOT want the bad publicity associated with having its ward die from refusing a few pennies worth of antibiotics or something even more basic like water.

I may have asked this before, but what if a prisoner just stops eating? No declarations, no defiance, no demands, just doesn’t get in the chow line or whatever. Maybe a couple of weeks pass and he’s noticeably thinner but won’t talk about it. How often would an inmate get a medical check/how soon might this come to the attention of officials? If he just refuses to cooperate with medical evaluation (but through remaining mute rather than physical resistance, or maybe purging after being tube fed) what would be done?

If they must be provided with medically necessary treatment, how is necessary determined? What qualifies or not?

Presumably as Qad suggests, any disputes are settled by a judge or by precedent.

I imagined it to begin with a decision to refuse a particular treatment for lack of necessity, that is disputed by the prisoner. Perhaps there is some standard is why I ask.

I can imagine viagra is not, but maybe/not hormone replacements for trans individuals ect.

So if a prisoner has a CPAP, then there has to be an electrical outlet in the cell, right? How is that handled? Like, every cell has standard outlets? Seems like an easy way to harm yourself or others. Are they all GFCI?

The practitioner does so, in accordance with the standard of care in the community. A guy wants his ACL repaired to he can play basketball better? No, the standard of care is to repair it if the tear prevents normal functioning for the typical patient, and such a repair would get it closer to normal functioning, not sports level functioning.

We’ve been sued for providing basic prostheses for missing limbs, rather than the high tech athletic prostheses. We’ve not lost those cases either.

Before it gets to court, there are reviews/appeals that can be made, etc. But if the Medical Director decides the standard of care is being upheld, over-ruling the practitioner’s decision is not likely.

Or an average risk patient age 50 wants a colonoscopy to screen for colon cancer. Well, that is one accepted way of screening for colon cancer, but the US Preventive task force also cites annual fecal occult blood screening and genetic screening of the stool for cancer cells every 3 years to be equally acceptable. So if he’s refusing annual screening in favor of a colonoscopy he’ll lose that case.

However, if he’s a high risk patient, such as one with a 1st degree relative with a hx of colon cancer, then colonoscopy is considered the preferred method, and he would get a colonoscopy.

The courts really don’t want to get involved in second guessing physicians and repeatedly dismiss cases where the patient was provided with acceptable options but was demanding a different course.

My father was a doctor in a large urban hospital, and he had several stories about prison inmates who spent time in his hospital because they had conditions beyond what could be treated in prison. So that happens, too. It’s expensive, however, because they come with guards who are assigned just to them.

One patient enjoyed the hospital so much more than prison (he had his own TV, and could watch whatever he liked. He had two guards who played cards with him, he got his pick from whatever the hospital cafeteria was offering that day) that he repeatedly injured himself to extend his stay.

Can’t eliminate all risks. Most inmates have access to electrical outlets and cords, for their TVs, etc. We don’t try to make the cells perfectly risk free for your typical low risk inmate. We have a cell specially constructed for Parkinson’s Disease patients, who during the final stage of their illness will try to harm themselves by any means possible. The room is padded all over and toilet facilities are minimalist in the extreme to prevent head banging on the equipment. No bed, no chairs, no appliances, just blankets for bedding/warmth. But that level safety is not needed for any but the most extreme inmates. Fortunately.

that type of patient is not uncommon, sadly. eventually we make their hospital confinement more stark, reducing entertainment and food choices.

Even so, many of these folks will continue to self mutilate, inserting you name it into any available orifice, or even make their own orifices. They know they’ll usually get at least some sedation during removal procedures, and maybe some opioid pain killers for a bit, afterwards.